Alternatives to standard cow milk: pros and cons

We provide a comprehensive review of non-bovine milk and so-called plant-based milk for clinicians. The differences between human and cow milk reflect the fact that milk has been shaped during the evolutionary history of each mammalian species to match the unique developmental needs of its infants. There is increasing interest in the concept that feeding strategies of herds might hardly influence the nutritional quality of milk. In Poland, as well as in other countries, the dairy industry is very influential in the development of dietary guidelines. However, there is an ongoing debate about the goodness of cow milk, and it tends to be highly polarized. Despite cow milk being privileged in governmental feeding programs, consumption of fluid cow milk is declining in traditional milk-drinking countries and there are movements which proclaim the virtues of non-bovine mammals' milk and plant-based alternatives to mammalian milk, i.e. oat, millet, buckwheat, dinkel wheat, corn, rice, soy, almond, hazelnut, earth almond (Cyperus esculentus), and hemp milk. Goat milk, like human milk, is secreted via an apocrine process and it contains high levels of free amino acids, nucleotides, polyamines, and polyunsaturated fatty acids including conjugated linolenic acid (CLA). Cow milk is secreted via a merocrine process and it is consequently less similar to breast milk than goat milk. Infants may be fed only modified goat milk. Where allergy to a major food group is confirmed in a patient, it is important to ensure a suitable alternative in the diet. Due to immunologic cross-reactivities between proteins from milk of ruminants, the routine use of goat, sheep, and buffalo milk in cow milk allergy is not recommended. In many cases cow milk proteins could be replaced with mare, donkey or camel milk. For older children plant-based milk does offer distinct advantages over extensively hydrolyzed formulas with regard to palatability and cost. Calcium remains the most trumpeted nutrient, symbolizing the inherent goodness and superiority of cow's milk as a food. However, most of the plant-based milk dispensed to the Polish market is highly supplemented with calcium (100-120 mg/dl).